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Historically, risk management and quality assurance have been treated as separate problems. It is now recognized that they are merely different approaches to the general problem of quality control. Both techniques aim to improve the quality of patient care, but the motivating forces behind them have been different. Risk management has been viewed as a technique to reduce financial losses. These losses may be due to a breach of legal duties, such as malpractice litigation, or they may result from statutory obligations, such as workers' compensation payments. Quality assurance, on the other hand, has been seen as a process for monitoring the quality of medical care delivered in hospitals, but not as a strategy for modifying that care.

There is no clear rationale for the separation of the two activities. Whether an administrator is setting up a new quality control program or consolidating existing risk management and quality assurance programs, there are five steps that must be followed to ensure the effectiveness of the integrated program. The administrator must:

1. develop a detailed description of the existing or proposed management structure, including informal communication channels

2. review the monitoring activities of each oversight committee to determine the scope of its review, the type of reports produced, the actions recommended in the reports, and the destination of the reports

3. review the standards that govern the hospital's (or clinic's) activities including the applicable state laws and the JCAH standards and guidelines

4. determine if proposed interventions are timely and appropriate to the situation

5. evaluate whether the various interventions are effective, ensuring that each oversight committee receives proper feedback on the results of the intervention it proposes so that the intervention it proposes so that the intervention strategies may be modified if necessary


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